1. Breathing Exercise Aims: 1.Promoting a normal relaxed pattern of breathing. 2- Assisting in removal of secretions. 3- Aiding in re-expansion of lung tissue. 4- Mobilizing the thoracic cage.

2. Precautions: When teaching breathing exercises, be aware of the following precautions: 1-Never allow a patient to force expiration. Expiration should be relaxed and passive. Forced expiration only increases turbulence in the airways, which can lead to bronchospasm and increased airway obstruction. 2-Do not allow a patient to take a very prolonged expiration. This causes the patient to gasp with the next inspiration. His breathing pattern then becomes irregular and inefficient.

3. 3-Do not allow the patient to initiate inspiration with the accessory muscles and the upper chest. Advise the patient that his upper chest should be relatively quiet during respiration. 4-Allow the patient to practice deep breathing for only 3 or 4 inspirations and expirations at a time to avoid hyperventilation.

4. Deep Breathing Exercises:

5. 1.Nose exercise Aims: To strength the diaphragm and the intercostal muscles. To increase expansion of the lungs. Loosening of thick secretions. Teach the patient the right way of breathing.

6. Graduations of Nose Exercises 1.Massage beside the nose (nose muscles) (for stimulation). 2.Feel the air at the tip of the nose. 3.Smelling of the surroundings. 4.Narrowing of one opening. 5.Shaking above the nose. 6.Sniffle (long breathing). 7.Snuffle (short breathing). 8.Massage beside the nose. (for relaxation).

7. Massage beside the nose Step (1 & 8) Feel the air at the tip of the nose Step (2 )

8. Smelling of the surrounding Step (3) Narrowing of the one opening Step (4)

9. Shaking above nose Step (5) Sniffle and snuffle Step (6 & 7)

10. .2-Pursed lips breathing: Aims: 1-Reduces the respiratory rate. 2-Increases tidal volume. 3-It relives dyspnea, increase exercise tolerance. 4-Pursed lips breathing prevent collapse of the small air ways as it reflect a positive pressure in the small air ways at the end of expiration which will prevent air trapping

12. 3-Diaphragmatic breathing exercise Aims: 1-To control breathing during attacks of dyspnea and during exertion. 2-To improve ventilation in the bases of the lungs and to loosen secretions.

13. - Set the patient in a comfortable position. - Place your hand in the patient’s abdomen. - Instruct the patient to breathe in into my hand. Feel your abdomen gently rise and push my hand upwards. - Begin with guiding the movement with your hands, and then increase the resistance gradually. - During expiration, resistance should not reduce suddenly; rather the weight of the hand should follow the abdomen back to the resting position. - When patient had mastered the breathing pattern in supine, progress to sitting, standing, walking and finally stairs.

16. II. Localized Breathing Exercise

17. Aims Localized breathing exercises help to ventilate isolated lobes of the lung which are useful for improving movement of the thoracic cage and for assisting in removal of secretions. Pressure is applied to appropriate areas of the chest wall utilizing proprioceptive stimuli so that efficient expansion of these areas may be obtained. The patient should be in half-lying position with the knees slightly flexed over a pillow

18. Apical

19. Lateral Costal Lower CostalUpper costal

20. Posterior Costal Sternal

21. III. Belt Exercise Length : 2 meters. Width : 30 cm. Advantages: - After operation as it make equal pressure in all points and takes a large area so it’s pressure become not painful which is more suitable for operative cases and fatly subjects. - Easy to be used by the patient himself. Disadvantages: - Trick movements are difficult to be noted. - Cannot be used for small and irregular areas.

23. IV.Exercises connected with respiration: This can give: mobilizing, strengthening and/or stretching exercise connected with respiration (expiration and/or inspiration). Upper limbs and lower limbs: - Abduction, Extension with inspiration. - Adduction, Flexion with expiration. Trunk: - Bending forward (flexion) with expiration. - Bending backward (extension) with inspiration. - Turning trunk with expiration.

24. . Exercise of the lower limb connected with breathing -Flexion and Extension exercise -of the trunk with breathing

25. -Exercise of Pectoralis major -connected with breathing.- Side Bending of the Trunk from Sitting Position -